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Health Care Reform:

Health Insurance & Affordable Care Act

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Denial of claim

A claim is a health care bill that goes to your health plan to be paid. If the health plan says they won’t pay it, they are denying the claim.

Your health plan will send you a letter to tell you why they denied the claim. That letter will also tell you how you can appeal it. The appeals process is the formal steps you take to ask a health plan to pay for something they said wasn’t covered.

All new health plans must explain their appeal process under the Affordable Care Act. But health plans that started or that you enrolled in before March 23, 2010, do not have to follow the same rules. Those plans are called grandfathered health plans.

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